More than 4.8 million American children (6 percent) lack health insurance. Among uninsured US children, 62-72 percent are eligible for but not enrolled in Medicaid or the Children’s Health Insurance Program (CHIP).
For uninsured, low-income children, 84 percent are eligible for but not enrolled in Medicaid/CHIP. Racial/ethnic disparities exist in insurance coverage for U.S. children: compared with an uninsured rate of 5 percent for white children, 12 percent of Latino, 8 percent of African-American, and 8 percent of Asian/Pacific Islander children are uninsured. Latino and African-American children comprise 57 percent of uninsured children, but only 42 percent of US children. Although millions of U.S. children continue to be uninsured, not enough is known about the most effective interventions for insuring uninsured children.
In this blog, I summarize exciting new research findings by our team from a study recently published in Pediatrics.
We conducted a randomized, controlled trial of the effects of Parent Mentors on insuring uninsured minority children. This trial is called Kids’ HELP, which stands for Kids’ Health Insurance by Educating Lots of Parents. Parent Mentors are experienced, minority mothers with at least one Medicaid- or CHIP-covered child who received two days of training, then assisted minority families in their own communities for one year with insurance applications, retaining coverage, medical homes, and social determinants of health, such as food insufficiency and housing issues. Controls received traditional Medicaid and CHIP outreach and enrollment. The primary outcome was obtaining health insurance one year after enrollment.
We enrolled 237 participants (114 controls and 123 in the Parent Mentor intervention group). Parent Mentors were significantly more effective than traditional Medicaid/CHIP methods in insuring children (at 95 percent vs. 68 percent, respectively), and achieving faster coverage (at a median of 62 days vs. 140 days), high parental satisfaction (84 percent vs. 62 percent) and coverage renewal (85 percent vs. 60 percent). The Parent Mentor group was less likely to have no primary-care provider (15 percent vs. 39 percent), problems getting specialty care (11 percent vs. 46 percent) unmet preventive-care needs (4 percent vs. 22 percent) or dental-care needs (18 percent vs. 31 percent), dissatisfaction with doctors (6 percent vs.16 percent), and needed additional income for medical expenses (6 percent vs. 13 percent).
The Parent Mentor group rated the quality of their well-child care higher than the control group (8.9 vs. 8.6 percent, on a scale of 1-10, where 10 is best). Two years after the Parent Mentor intervention ended, more Parent Mentor children were insured, at 100 percent vs. 76 percent. Parent Mentors cost $53.05 per child per month, but saved $6,045.22 per child insured per year.
One of our terrific Kids’ HELP Parent Mentors is Alma Baltazar, the mother of eight children who first enrolled her children in Medicaid in the 1990s after her husband became unemployed. She found the whole process confusing and overwhelming; indeed, at first, after applying, she wasn’t even certain that her children qualified. As she described in a recent interview for a story in the Boston Globe “The only thing I heard about government help or welfare was on the TV, and I thought, ‘Do they have this in my state?’ I didn’t really know if there was help out there,” she noted. When she went to the Medicaid office to apply, “the lady was so mean and rude, which made me feel more ashamed to be asking them for help,” Baltazar said. “It was intimidating.”
The feedback from Kids’ HELP Parent Mentors, participating families, and community partners has been very positive. The Kids’ HELP train-the-trainer resource and further information are available here.
In conclusion, Parent Mentors were found to be significantly more effective than traditional methods in insuring uninsured minority children; obtaining insurance faster; renewing coverage; improving access to primary, dental, and specialty care; reducing unmet needs and out-of-pocket costs; achieving parental satisfaction and well-child care quality; and sustaining long-term coverage. The intervention is inexpensive, and saved $6,045.22/insured child.
There are several important implications of these study findings for the public, policymakers, and researchers. The study results suggest that implementing Parent Mentor interventions in health plans, state Medicaid and CHIP programs, or nationally might potentially result in considerable cost savings. Hypothesizing that Parent Mentor interventions might have a similar efficacy when implemented on a larger scale and in other regions, national implementation of Kids’ HELP could save $9.8-$11.5 billion.
Assuming that Parent Mentors also could be effective for uninsured children of all races/ethnicities, similar calculations suggest that national implementation of Parent Mentor interventions to insure all Medicaid/CHIP-eligible uninsured children could save $17.2-$20.1 billion.
Kids’ HELP results in multiple benefits: more children are insured faster, children’s access to healthcare and parental satisfaction improve, quality of well-child care is enhanced, thousands of dollars are saved per child, jobs are created, disparities are eliminated, and the intervention potentially could save our nation billions of dollars.
These findings suggest that Parent Mentors and analogous peer mentors for adults might prove to be highly cost-effective interventions for reducing or eliminating insurance disparities and insuring all Americans.
Glenn Flores, MD, AAP, is a board member of First Focus, a Distinguished Chair of Health Policy Research, Medica Research Institute, Minneapolis, MN; Research Affiliate, Department of Health Sciences Research, Mayo Clinic, Rochester, MN; and Adjunct Professor, Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. Dr. Flores’s research focus is health policy, the health and healthcare of underserved children, the uninsured, and racial/ethnic and linguistic disparities in healthcare.
This post was originally published on Voices for Kids Blog.